Surveillance 2017 Division of STD Prevention Gonorrhea Gonorrhea Rates of Reported Cases by Year United States 19412017 NOTE Data collection for gonorrhea began in 1941 however gonorrhea became nationally notifiable in 1944 Refer to the National Notifiable Disease Surveil ID: 745823
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Slide1
Sexually Transmitted Disease
Surveillance 2017
Division
of STD Prevention
GonorrheaSlide2
Gonorrhea — Rates of Reported Cases by Year, United States, 1941–2017
NOTE: Data collection for gonorrhea began in 1941; however, gonorrhea became nationally notifiable in 1944. Refer to the National Notifiable Disease Surveillance System (NNDSS) website for more information: https://wwwn.cdc.gov/nndss/conditions/gonorrhea/Slide3
Gonorrhea — Rates of Reported Cases by Region, United States, 2008–2017Slide4
Gonorrhea — Rates of Reported Cases by State, United States and Outlying Areas, 2017
NOTE: The total rate of reported cases of gonorrhea for the United States and outlying areas (including Guam, Puerto Rico, and the Virgin Islands) was 170.3 per 100,000 population. See Section A1.11 in the Appendix for more information on interpreting reported rates in the outlying areas.ACRONYMS: GU = Guam; PR = Puerto Rico; VI = Virgin Islands.Slide5
Gonorrhea — Rates of Reported Cases by
County, United States, 2017NOTE: Refer to the NCHHSTP AtlasPlus for further county-level rate information:
https://www.cdc.gov/nchhstp/atlas/.Slide6
Gonorrhea — Rates of Reported Cases by Sex, United States, 2008–2017Slide7
Gonorrhea — Rates of Reported Cases by Age Group and Sex, United States, 2017Slide8
Gonorrhea — Rates of Reported
Cases Among Women Aged 15–44 Years by Age Group, United States, 2008–2017Slide9
Gonorrhea — Rates of Reported Cases Among Men Aged 15–44 Years by Age Group, United States, 2008–2016Slide10
Gonorrhea — Rates of Reported Cases by
Race and Hispanic Ethnicity, United States, 2013–2017NOTE: Not all US jurisdictions reported cases in OMB-compliant Race categories in 2017. This may minimally under- or overestimate rates for Asians, NHOPI, or Multirace individuals. For completeness, data in this figure include cases reported from all jurisdictions. See Section A1.5 in the Appendix for information on reporting STD case data for race and Hispanic ethnicity.
ACRONYMS: AI/AN = American Indians/Alaska Natives; NHOPI = Native Hawaiians/Other Pacific Islanders; OMB = Office of Management and Budget.Slide11
Gonorrhea — Percentage of Reported Cases Among
Men by Reporting Source*, United States, 2008–2017* Includes the top five reporting sources for gonorrhea cases reported among men, plus those with reporting sources categorized as “All Other” and “Missing/Unknown”.
NOTE: All Other includes: Drug Treatment, Tuberculosis Clinic, Correctional Facility, Laboratory, Blood Bank, Labor and Delivery, Prenatal Care, National Job Training Program, School-based Clinic, Mental Health Provider, Indian Health Service, Military, Family Planning, HIV Counseling and Testing Site, and Other.ACRONYMS:
HMO = health maintenance organization; HD = health department.Slide12
Gonorrhea — Percentage of Reported Cases
Among Women by Reporting Source*, United States, 2008–2017* Includes the top five reporting sources for gonorrhea cases reported among women, plus those with reporting sources categorized as “All Other” and “Missing/Unknown”.
NOTE: All Other includes: Drug Treatment, Tuberculosis Clinic, Correctional Facility, Blood Bank, Labor and Delivery, Prenatal Care, National Job Training Program, School-based Clinic, Mental Health Provider, Indian Health Service, Military, Emergency Room, Other Health Department Clinic, HIV Counseling and Testing Site, and Other.ACRONYMS:
HMO = health maintenance organization.Slide13
Estimated Proportion* of MSM, MSW, and Women Among Gonorrhea Cases by Jurisdiction, STD
Surveillance Network (SSuN), 2017* Estimate based on weighted analysis of data obtained from interviews (n=6,409) conducted among a random sample of reported gonorrhea cases during January to December 2017. † California data exclude
San Francisco (shown separately). NOTE: See section A2.2 in the Appendix for SSuN
methods.ACRONYMS:
MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); MSW = Men who have sex with women only.Slide14
Gonorrhea — Estimated* Rates of Reported Gonorrhea Cases by MSM, MSW, and Women, STD Surveillance Network (
SSuN)†, 2010–2017* Estimates based on interviews among a random sample of reported cases of gonorrhea (N=17,765); cases weighted for analysis.† Sites include Baltimore, Philadelphia, New York City, Washington State, San Francisco, and California (excluding San Francisco).NOTE:
Data not available for 2014; 2013–2015 trend interpolated; trends lines overlap for MSW and women in this figure. See section A2.2 in the Appendix for SSuN methods.
ADAPTED FROM: Stenger M, Pathela P,
Anschuetz
G, et al. Increases in the rate of
Neisseria
gonorrhoeae
among gay, bisexual and other men who have sex with men (MSM) — findings from the STD Surveillance Network 2010–2015. Sex
Transm
Dis 2017; 44(7): 393–397.
ACRONYMS:
MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); MSW = Men who have sex with women only.Slide15
Gonorrhea — Proportion* of STD Clinic Patients
Testing Positive† by Age Group, Sex, and Sexual Behavior, STD Surveillance Network (SSuN), 2017* Proportions represent the overall average of the mean value by jurisdiction. † Results are based on data obtained from unique patients with known sexual behavior (n=94,893) attending
SSuN STD clinics who were tested ≥1 times for gonorrhea in 2017.NOTE: See section A2.2 in the Appendix for
SSuN methods.ACRONYMS:
MSM = Gay, bisexual, and other men who have sex with men (collectively referred to as MSM); MSW = Men who have sex with women only.Slide16
Location of Participating Sentinel Sites and
Regional Laboratories, Gonococcal Isolate Surveillance Project (GISP), United States, 2017NOTE: Seattle is both a sentinel site and a regional laboratory.Slide17
Neisseria
gonorrhoeae — Percentage of Isolates with Elevated Azithromycin Minimum Inhibitory Concentrations (MICs) (≥2.0 µg/ml), Elevated Ceftriaxone MICs (≥0.125 µg/ml), and Elevated Cefixime MICs (≥0.25 µg/ml), Gonococcal Isolate Surveillance Project (GISP), 2008–2017NOTE: Isolates not tested for cefixime susceptibility in 2008.Slide18
Neisseria gonorrhoeae
— Distribution of Gentamicin Minimum Inhibitory Concentrations (MICs) by Year, Gonococcal Isolate Surveillance Project (GISP), 2015–2017Slide19
Neisseria
gonorrhoeae — Prevalence of Tetracycline, Penicillin, or Fluoroquinolone Resistance* or Elevated Cefixime, Ceftriaxone, or Azithromycin Minimum Inhibitory Concentrations (MICs)†, by Year — Gonococcal Isolate Surveillance Project (GISP), 2000–2017* Resistance: Fluoroquinolone (ciprofloxacin) = MIC≥ 1.0 µg/mL; Penicillin = MIC≥
2.0 µg/mL or B-lactamase positive; Tetracycline = MIC≥ 2.0 µg/
mL.† Elevated MICs: Azithromycin =
MIC≥
1.0 µg/mL (2000–2004); ≥ 2.0 µg/mL (2005–2017); Ceftriaxone =
MIC≥
0.125 µg/mL;
Cefixime
=
MIC≥
0.25 µg/
mL.
NOTE:
Cefixime
susceptibility was not tested in 2007 and 2008.
ADAPTED FROM:
Kirkcaldy RD, Harvey A, Papp JR, et al.
Neisseria
gonorrhoeae
antimicrobial susceptibility surveillance — The Gonococcal Isolate Surveillance Project, 27 Sites, United States, 2014. MMWR
Surveill
Summ
2016; 65(7):1–24.Slide20
Susceptibility Patterns of
Neisseria gonorrhoeae Isolates to Antimicrobials, Gonococcal Isolate Surveillance Project (GISP), 2017* Susceptible category only includes isolates with penicillin, tetracycline, and fluoroquinolone MIC values that are considered susceptible and isolates with ceftriaxone, cefixime, and azithromycin MIC values that are not considered elevated. NOTE:
Elevated MIC = Ceftriaxone: ≥0.125 μg/ml; Cefixime
: ≥0.25 μg/ml; Azithromycin: ≥2.0
μ
g/ml.
Resistant (R) MIC = Tetracycline: ≥2.0
μ
g/ml; Fluoroquinolone: ≥1.0
μ
g/ml; Penicillin: ≥2.0
μ
g/ml or PPNG.
ACRONYMS:
R = Resistant; PPNG =
Penicillinase
-producing
Neisseria
gonorrhoeae
and chromosomally-mediated penicillin-resistant
N.
gonorrhoeae
; MIC = Minimum Inhibitory Concentration. Slide21
Distribution of Primary Antimicrobial Drugs Used to Treat
Gonorrhea Among Participants, Gonococcal Isolate Surveillance Project (GISP), 1988–2017NOTE: For 2017, “Other” includes azithromycin 2g (0.3%), no therapy (0.3%), and other less frequently used drugs (0.1%).Slide22
Gonorrhea – Estimated Proportion* of Cases by Treatment Regimen Received and Jurisdiction
†, STD Surveillance Network (SSuN), 2017 * Percentage and 95% CI reflect weighted estimates for all reported gonorrhea cases; minor variances cause category estimates to total to slightly more or less than overall case estimate. † Includes SSuN
jurisdictions with documented treatment information (antimicrobials and dosages) for ≥90% of cases with complete investigations. ‡ The recommended treatment for uncomplicated gonorrhea is dual treatment with 250 mg dose of Ceftriaxone [IM] plus 1 g dose of Azithromycin [PO].
§ California data
exclude
San Francisco.
ADAPTED FROM:
Weston EJ,
Workowski
K,
Torrone
E, et al. Adherence to CDC recommendations for the treatment of
uncompllicated
gonorrhea – STD Surveillance Network (
SSuN
), United States, 2016. MMWR
Morb
Mort
Wkly
Rep. 2018; 67:473–76.
ACRONYMS:
CI = Confidence interval; GC = Gonorrhea; IM = Intramuscular injection; PO = By mouth.Slide23